
	<div class="page-header">
	<h1>会員登録</h1>
	</div>

    <form class="form-horizontal" role="form" action="<?php echo base_url(); ?>index.php/customer/regist" method="post">

		<!-- id -->
		<div class="form-group">
			<label for="login_id" class="col-sm-2 control-label">ID</label>
			<div class="col-sm-4">
				<input type="hidden" class="form-control" id="login_id" name="login_id" value="<?=$login_id?>" >
				<?=$login_id?>
			</div>
		</div>

		<!-- password -->
		<div class="form-group">
			<label for="password" class="col-sm-2 control-label">PASSWORD</label>
			<div class="col-sm-4">
				<input type="hidden" class="form-control" id="password" name="password" value="<?=$password?>" >********
			</div>
		</div>

		<!-- email -->
		<div class="form-group">
			<label for="email" class="col-sm-2 control-label">EMAIL</label>
			<div class="col-sm-6">
				<input type="hidden" class="form-control" id="email" name="email" value="<?=$email?>" ><?=$email?>
			</div>
		</div>

		<!-- first_name -->
		<div class="form-group">
			<label for="first_name" class="col-sm-2 control-label">性</label>
			<div class="col-sm-4">
				<input type="hidden" class="form-control" id="first_name" name="first_name" value="<?=$first_name?>" ><?=$first_name?>
			</div>
		</div>

		<!-- last_name -->
		<div class="form-group">
			<label for="last_name" class="col-sm-2 control-label">名</label>
			<div class="col-sm-4">
				<input type="hidden" class="form-control" id="last_name" name="last_name" value="<?=$last_name?>" ><?=$last_name?>
			</div>
		</div>

		<!-- first_name_kana -->
		<div class="form-group">
			<label for="first_name_kana" class="col-sm-2 control-label">性（カナ）</label>
			<div class="col-sm-4">
				<input type="hidden" class="form-control" id="first_name_kana" name="first_name_kana" value="<?=$last_name_kana?>" ><?=$last_name_kana?>
			</div>
		</div>

		<!-- last_name_kana -->
		<div class="form-group">
			<label for="last_name_kana" class="col-sm-2 control-label">名（カナ）</label>
			<div class="col-sm-4">
				<input type="hidden" class="form-control" id="last_name_kana" name="last_name_kana" value="<?=$last_name_kana?>" ><?=$last_name_kana?>
			</div>
		</div>


	  <div class="form-group">
	    <div class="col-sm-offset-2 col-sm-10">
	      <div class="checkbox">
	        <label>
	          <input type="checkbox"> Remember me
	        </label>
	      </div>
	    </div>
	  </div>

	  <div class="form-group">
	    <div class="col-sm-offset-2 col-sm-10">
	      <button type="submit" class="btn btn-default">登録する</button>
	    </div>
	  </div>

	</form>

